During the off-site component of the comprehensive CDM review, St. Clair checks the CPT/HCPCS and Revenue Codes and Service Descriptions of all Hospital ancillary services for compliance with the CMS regulations and the applicable Local Medical Review Policies. Also, we check the Hospital and/or Medicare billing edit reports for any frequently repeating coding/billing errors in order to identify any caused by CDM problems.

    In on-site individual meetings with ancillary departments, St. Clair will confirm our preliminary findings and recommendations and provide an educational in-service. We also perform an audit of the UB-04s against the coded ambulatory services per the medical record for a sample of Medicare outpatient visits in order to identify any CDM problems. As an option, St. Clair will arrange to have Cleverley & Associates prepare a Competitive Pricing Report with the client’s selected individual hospital peers and with the regionally adjusted APC payment rates and Medicare fee schedule.

At the exit conference, St. Clair will discuss those CDM line items, for which changes in CPT/HCPCS and Revenue codes and/or service descriptions are recommended, and discuss the findings from the Outpatient Coding/Billing/APC review. A draft of the final report on the CDM review findings and recommendations, with supporting documentation, will be provided within two weeks after the exit conference. Only after obtaining sign-off as to resolution of all hospital questions regarding the review findings and recommendations, will St. Clair issue the final report, including recommended CDM code changes in the same Excel spreadsheet format as provided by the Hospital.

Quarterly or annual ongoing CDM maintenance programs are available.

Our CDM review establishes accurate CPT/HCPCS and Revenue codes in the Hospital charging which assures proper payer payments. 

    The St. Clair professional fee for a comprehensive CDM review is competitively priced on consultant days required to complete the engagement, plus out of pocket expenses.